Endoscopy 2018; 50(06): E126-E127
DOI: 10.1055/s-0044-101025
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Clip-fixed endoloop: an efficacious new method for mucosal defect closure

Tatsuma Nomura
1  Department of Gastroenterology, Kinan Hospital, Minamimuro, Mie, Japan
,
Makoto Kobayashi
2  Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
,
Takaaki Morikawa
1  Department of Gastroenterology, Kinan Hospital, Minamimuro, Mie, Japan
,
Noriyuki Horiki
3  Department of Endoscopy, Mie University School of Medicine Tsu, Mie, Japan
› Author Affiliations
Further Information

Corresponding author

Tatsuma Nomura, MD
Department of Gastroenterology
Kinan Hospital
4750 Atawa, Mihama-cho
Minamimuro-gun
Mie 519-5293
Japan   
Fax: +815-9792-3357   

Publication History

Publication Date:
21 February 2018 (eFirst)

 

Endoloop suturing of a mucosal defect using a two-channel scope has been shown to be efficacious [1] [2]. Recently, methods of simple, useful endoloop suturing with a single-channel scope have also been reported [3] [4]. However, fixing the first clip to determine the position of the endoloop is cumbersome. We have developed a new and efficient suturing method, the clip-fixed endoloop, that fixes the endoloop to the clip in advance.

The clip-fixed endoloop consists of the clip (ZEOCLIP ZP-CH; Zeon Medical Inc.), a clip applicator (ZP-S-195S; Zeon Medical Inc.), an endoloop (MAJ254; Olympus), and a surgical thread ([Fig. 1 a]). [Video 1] shows how to perform mucosal closure using the clip-fixed endoloop. First, the tip of endoloop is fixed to the clip’s teeth with surgical thread ([Fig. 1 b]). The clip-fixed endoloop is housed in the outer sheath of the clip by moving the outer slider distally until the clip-fixed endoloop is completely hidden in the outer sheath ([Fig. 1 c]). It is opened by slowly moving the outer sheath until it is endoscopically confirmed that the endoloop is properly open.

Zoom Image
Fig. 1 Photographs of the clip-fixed endoloop. a The device consists of a clip, clip applicator, endoloop, and surgical thread. b The tip of the endoloop is fixed to the clip’s teeth with surgical thread. c The clip-fixed endoloop is housed in the outer sheath of the clip by moving the outer slider distally.

Video 1 The clip-fixed endoloop is prepared and then used to suture a mucosal defect after colorectal endoscopic submucosal dissection.

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[Video 1] shows how the mucosal defect is sutured after colorectal endoscopic submucosal dissection (ESD) using the clip-fixed endoloop. The patient had a 40-mm sessile serrated adenoma in the descending colon. ESD was performed; the area of the mucosal defect after ESD was slightly larger than 40 mm ([Fig. 2 a]). The clip-fixed endoloop was inserted through the working channel of the endoscope and was confirmed to be opening properly ([Fig. 2 b]). It was then fixed onto the normal mucosa near the mucosal defect ([Fig. 2 c]). Four metal clips were used to anchor the endoloop around the edge of the mucosal defect. The endoloop tail was then grasped by a hook device (HX-20Q-1; Olympus) and the endoloop was tightened to close the defect. Additional clips were added to the remaining mucosal defect to ensure it was completely sutured ([Fig. 2 d]).

Zoom Image
Fig. 2 Endoscopic images showing: a a mucosal defect with an area > 40 mm post-endoscopic submucosal dissection; b the clip-fixed endoloop, which has been inserted into the working channel of the endoscope, and is confirmed to be opening properly; c the clip-fixed endoloop having been fixed to the normal mucosa near the mucosal defect; d complete closure of the mucosal defect following application of the clip-fixed endoloop and a number of additional clips.

By fixing the endoloop to the clip in advance and housing it in the outer sheath, we have made simple and efficient suturing of a mucosal defect possible.

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Competing interests

None


Corresponding author

Tatsuma Nomura, MD
Department of Gastroenterology
Kinan Hospital
4750 Atawa, Mihama-cho
Minamimuro-gun
Mie 519-5293
Japan   
Fax: +815-9792-3357   


Zoom Image
Fig. 1 Photographs of the clip-fixed endoloop. a The device consists of a clip, clip applicator, endoloop, and surgical thread. b The tip of the endoloop is fixed to the clip’s teeth with surgical thread. c The clip-fixed endoloop is housed in the outer sheath of the clip by moving the outer slider distally.
Zoom Image
Fig. 2 Endoscopic images showing: a a mucosal defect with an area > 40 mm post-endoscopic submucosal dissection; b the clip-fixed endoloop, which has been inserted into the working channel of the endoscope, and is confirmed to be opening properly; c the clip-fixed endoloop having been fixed to the normal mucosa near the mucosal defect; d complete closure of the mucosal defect following application of the clip-fixed endoloop and a number of additional clips.